https://orcid.org/0000-0003-0225-8489
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ABSTRACT
The field of medicine is traditionally associated with opportunities for training and knowledge sharing through movement and travel. Nevertheless, the contemporary migration of doctors may have negative impacts on lower-income countries. Some scholars argue for active restrictions on South to North migration of medical doctors, while others consider such suggestions as an unjustified infringement on individual rights to migrate. This paper draws on mobility justice and the capabilities approach, to conceptualise the complex dynamics of international medical migration through the example of Aotearoa New Zealand. In this context, a ‘brain drain’ of New Zealand-trained medical doctors is partially mitigated by a ‘brain gain’, with more than 40% of the medical workforce having trained overseas. However, overseas-trained medical doctors follow pathways to licensing determined by the public health indicators of their countries of training. Despite an overall ‘brain gain’, doctors who trained in the Global South experience significantly greater barriers to registration than those who trained in Global North countries. Many are unable to work as doctors, resulting in a ‘brain waste’ of their knowledge, experience, and capabilities. This may relate to (post)colonial legacies and discourses of medical competencies that underscore the hegemony of the Global North, warranting further exploration.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Notes
1 Doctors who migrate to another country after graduating from medical school are often referred to as ‘International Medical Graduates’ or ‘IMGs’ (MCNZ Citation2022, 5). Please note that this does not exclusively refer to recent graduates, who do not have any overseas or local clinical experience – ‘IMG’ refers to any doctor who obtained their primary medical qualification overseas, independent of their clinical experience.
2 This is also referred to as the ‘capability approach’ (e.g. Robeyns Citation2017).
3 This example focuses on the non-specialist licensing pathways for overseas-trained doctors (IMGs), as these are clearly defined by MCNZ. There are no definitive registration requirements for doctors specialised in a particular field of medicine beyond their baseline medical qualifications (specialists), as these are decided on a case-by-case basis. However, it is unlikely that IMGs whose foundational, non-specialised medical qualifications are not eligible for the AUS, CA, or CHS pathways would have their specialist qualifications from that same country recognised in Aotearoa New Zealand. This was seen in a recent case of a U.K.-trained specialist, whose original medical degree was from Hungary, being unable to work in his specialty field (Walker Citation2023).
4 Official information requests from all of the public hospitals in Aotearoa New Zealand where PGY1 positions are available revealed that 553 PGY1 positions were available in total in 2020 (Anjaria Citation2022; Ash Citation2022; Brown Citation2022; Dougan Citation2022; Fleming Citation2022; Green Citation2022; La Salle Citation2022; Low Citation2022; McCarthy, Citation2022; McKinnon Citation2022; O’Shea Citation2022; Saville-Wood Citation2022; Schiebli Citation2022; Sheffield Citation2022; Shepherd Citation2022; Sherborne Citation2022; Smitheram Citation2022; Watson Citation2022). By comparison, 561 doctors graduated from New Zealand medical schools in 2019 (Medical Deans Australia and New Zealand Citation2021) and were thus eligible for these positions.
5 Each MCNZ update replaces the previous one and so the status updates prior to May 2023 are no longer publicly available online.